Prevalence and characteristics of MIH in school children residing in an endemic fluorosis area of India: an epidemiological study

Is there a rise of prevalence for Molar Incisor Hypomineralization? A meta-analysis of published data

Since Molar Incisor Hypomineralization was first described as a pathologic entity, public perception often suggests a considerable rise in prevalence of the respective disease. Since there are still considerable doubts regarding the etiology and-accordingly-prevention of MIH and respective therapeutic approaches are difficult this question is of considerable clinical and public interest. Accordingly, a systematic literature search in accordance with the PRISMA guidelines for systematic reviews on Medline, Cochrane Database, EMBASE, LILACS, Web of Science, Google scholar, Scopus was performed to retrieve original articles reporting the prevalence of MIH as defined by the European Academy of Pediatric Dentistry (EAPD). From initially 2360 retrieved titles, 344 full texts were assessed for possible inclusion and finally 167 articles of mainly moderate to high quality and based on data of 46'613 individuals were included in the meta-analysis. All studies published before 2001 had to be excluded since it was not possible to align the findings with the EAPD classification. Studies varied considerably regarding cohort size (25 to 23'320, mean 1'235)) and age (5.6-19 y, mean 9.8 y). Over all studies, the weighted mean for the prevalence for MIH was 12.8% (95% CI 11.5%-14.1%) and no significant changes with respect to either publication year or birthyear were found. A sub-analysis of eleven studies reporting on the prevalence in different age groups, however, revealed strong evidence for an increasing prevalence between the years 1992 (3%) and 2013 (13%).Therefore, based on data from cross-sectional studies a possible rise in prevalence of MIH remains unclear. Future prospective large-scale studies under standardized examination conditions with an emphasis on examiner calibration are needed to gain better understanding in the evolution of the prevalence of MIH.

MIH and Dental Caries in Children: A Systematic Review and Meta-Analysis

(1) Background: Molar-incisor hypomineralization (MIH) is a clinical condition affecting permanent teeth in children, with a documented rising trend in the last two decades. The aim of the present study was to analyze and synthesize the available evidence on caries experience (dmft/DMFT) and MIH in children. (2) Methods: A systematic review and meta-analysis were conducted according to the PRISMA statement. (3) Results: 59 papers published between 2007 and 2022 were included in the qualitative synthesis and 18 in the meta-analysis. The total sample of subjects was 17,717 (mean: 896), of which 2378 (13.4%) had MIH (mean: 119), with a girl/boy ratio of 1:1. The mean age of the enrolled participants was 8.6 (age range 7-10 years). Meta-analysis showed that MIH has a positive correlation with both dmft (effect size of 0.67, 95% CI [0.15, 1.19]) and DMFT (effect size of 0.56, 95% CI [0.41, 0.72]); (4) Conclusions: Children with MIH should be diagnosed correctly and on time. Treatment and management options for moderate and severe forms of MIH should consider prognosis based on known risk factors, and secondary and tertiary prevention policies should also consider the multifactorial nature of caries etiology.

Prevalence, Severity and Associated Risk Indicators of Molar Incisor Hypomineralization amongst 8-13-year-old Children of Vadodara District Gujarat: A Cross-sectional Study

Context

Molar incisor hypomineralization (MIH) is an emerging clinical problem as the affected tooth is prone to dental caries with the lapse of time.

Aims

To assess the prevalence, severity, and associated risk indicators of MIH amongst 8-13 years of children of Vadodara District, Gujarat, India.

Materials and methods

A cross-sectional study with a sample size of 3,000 government schoolchildren. A total of 1,500 children each from urban and rural areas were randomly selected and examined. Only permanent incisors and first molars were examined. MIH was diagnosed clinically based on the diagnostic criteria established by the European Academy of Paediatric Dentistry (EAPD), 2003. To check the relation between the two variables-Pearson's chi-squared test was applied. Fisher's exact test was applied when less than five expected values were found.

Results

A total of 286 children (9.6 %) had MIH, with 189 (rural) and 97 (urban) children. MIH was significantly higher in the rural population as compared to the urban. In the rural area, the cause was found to be a child suffering from an illness (>15 days) which was 35.98%, and in the urban area was due to prolonged use of antibiotics before 4 years of age, which was 28.87%.

Conclusion

The overall prevalence rate of MIH among the screened children between the age-group 8 and 13 was found to be 9.6%. Males were more affected. The severity of MIH was more in molars compared to incisors and more in children of rural areas.

Clinical significance

Protocol for early diagnosis and follow-up to access the squeal of breakdown should be undertaken along with parents and health workers.

How to cite this article

Shah VU, Dave BH, Chari DN, et al. Prevalence, Severity and Associated Risk Indicators of Molar Incisor Hypomineralization amongst 8-13-year-old Children of Vadodara District Gujarat: A Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(2):280-286.

Are yellow-brownish opacities in hypomineralized teeth more prone to breakage than white-creamy ones? A systematic review

OBJETIVE

To evaluate all the available evidence assessing if in hypomineralized teeth, yellow-brownish opacities are more prone to post-eruptive breakdown (PEB) compared to white-creamy opacities.

MATERIALS AND METHODS

Observational studies that evaluated the occurrence of PEB in hypomineralized teeth were considered for inclusion. Electronic searches were performed up to January 2022 in MedLine, LILACS, BBO, Cochrane Library, Web of Science, Scopus, and EMBASE. Neither publication date nor language restrictions were imposed to the searches. Two researchers independently performed the study selection, data extraction, and quality assessment of the included studies according to the Newcastle-Ottawa Scale (NOS). Datasets from studies were grouped for narrative synthesis based on the severity of the PEB (enamel or dentin), type of tooth (molar or incisor), unit of analysis (subject or tooth or tooth surface), and follow-up period (in months). The certainty of evidence was evaluated using the GRADE approach.

RESULTS

Nine studies were included, five cohort and three cross-sectional. All studies assessed the opacities and PEB by visual examination and diagnosed MIH according to EAPD criteria. In the cohort studies, considering all follow-up periods (ranging from 6 to 36 months), dark opacities fractured more than light opacities, at both enamel and enamel/dentin levels, and molars fractured more than incisors. In two out of three cross-sectional studies, dark opacities also fractured more than light opacities, but the deep of the PEB (enamel or dentin breakdown) or the type of tooth (molar or incisor) was not considered in the analysis.

CONCLUSION

Although it seems plausible to state that darker demarcated opacities in MIH patients broke more often than light ones, based on this systematic review of the literature, the certainty of the available evidence about this association is still very low.

CLINICAL RELEVANCE

More reliable and valid research is still necessary to support any future recommendation that MIH children who present yellow-brownish opacities should be monitored at shorter intervals compared to those who present only white-creamy opacities.

Molar Incisor Hypomineralization: Prevalence, Associated Risk Factors, Its Relation with Dental Caries and Various Enamel Surface Defects in 8–16-year-old Schoolchildren of Lucknow District

Introduction

Aim

Methodology

Results

Conclusion

Clinical significance

How to cite this article

Prevalence, Pattern, and Severity of Molar Incisor Hypomineralization in 8-12-year-old Schoolchildren of Moradabad City

Aim and objective

Recently, molar incisor hypomineralization (MIH) has become more evident and one of the most common reasons for loss of teeth in children after dental caries. Being a country with a diverse ethnic population, the prevalence of MIH in different regions of India may differ. Hence, the present study was undertaken to determine the prevalence, pattern, and severity of MIH in 8-12-year-old Schoolchildren in Moradabad city.

Materials and methods

This study was conducted in various schools of Moradabad city to target a sample of 2,300 children aged between 8 and 12 years. The examination was done in their respective schools by a calibrated examiner in natural daylight using European Academy of Pediatric Dentistry diagnostic criteria for MIH 2015. The results, thus obtained, were statistically analyzed using Pearson's Chi-square test.

Results

A prevalence of 3.96% (91/2300) for MIH was reported without any gender predilection. Molar hypomineralization showed a prevalence of 1.3% (29/2300) whereas the prevalence for hypomineralization of second primary molars was 1.4% (22/1620). The most common type of defect was type 2 and most of the affected teeth were of grade I. Mandibular molars were more commonly affected compared to the maxillary molars.

Conclusions

A prevalence of 3.96% (91/2300) was observed for MIH. Frequent dental screening camps should be organized in schools at the community level for the enhancement of early diagnosis of MIH and designing appropriate management strategies.

How to cite this article

Khan A, Garg N, Mayall SS, et al. Prevalence, Pattern, and Severity of Molar Incisor Hypomineralization in 8-12-year-old Schoolchildren of Moradabad City. Int J Clin Pediatr Dent 2022;15(2):168-174.

The prevalence of molar-incisor hypomineralization: a systematic review and meta-analysis

Molar-Incisor Hypomineralization (MIH) is a qualitative defect of enamel of unknown etiology, affecting one or more permanent molars and may include incisors. This condition is a clinical challenge and its prevalence is still uncertain given the recent increase in research. Thus, we aimed to comprehensively estimate the overall prevalence of MIH and associated characteristics. This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, MEDLINE, CENTRAL, Web of Science, SciELO, LILACS and TRIP databases, until July 2021. Heterogeneity and publication bias were computed via I2 test statistics and Egger's significance test, respectively. Random-effects meta-analysis of prevalence were processed. We used the Strength of Recommendation Taxonomy [SORT] to grading the strength of evidence. Overall, 116 observational studies were included, with one study with moderate methodological quality and the remaining of high methodological quality. Subgroup analysis confirmed an influence of not using the 2003 MIH case definition (p = 0.0066). The pooled prevalence of MIH was 13.5% (95% CI 12.0-15.1, I2 = 98.0%). Affected incisors were seen in 36.6% (95% CI 30.0-43.7, I2 = 92.5%) of the cases. Lastly, the prevalence of hypomineralization of the second primary molars was observed in 3.6% of the MIH cases (95% CI 1.9-6.8, I2 = 96.3%). America was the continent with highest prevalence (15.3, 95% CI 12.8-18.3, p < 0.001, I2 = 96.3%) and Asia had the lowest prevalence (10.7, 95% CI 8.5-13.5, p < 0.001, I2 = 98.7%), however no continental differences were found. Sample size and year of publication were slight contributing factors to the heterogeneity in the analysis. Overall, these results were classified with a SORT A recommendation.

Molar Incisor Hypomineralization Prevalence in the Schoolchildren of Gannavaram Mandal, Krishna District, Andhra Pradesh, India: A Cross-sectional Study

AIM AND OBJECTIVES

To evaluate the prevalence of molar incisor hypomineralization (MIH) in schoolchildren of the ages between 8 and 14 years of Gannavaram Mandal, Krishna district, Andhra Pradesh, India.

MATERIALS AND METHODS

A total of 2,250 children of ages between 8 and 14 years were selected randomly from different schools. After obtaining requisite permissions from Mandal Educational Officer (MEO), children was screened for the prevalence of MIH according to European Academy of Paediatric Dentistry (EAPD) 2003 diagnostic criteria and severity for MIH was examined using Wetzel and Reckel scale.

RESULTS

Prevalence of MIH was observed to be 2.1% with higher cases of mild severity and with no sex predilection (p > 0.05).

CONCLUSION

Early diagnosis and treatment can significantly reduce complications associated with MIH. Very few studies have been conducted in India and studies encompassing extensive population are warranted to better understand its etiology.

CLINICAL SIGNIFICANCE

MIH lesions lead to carious development. Hence there is need to identify MIH in children as early as possible to reduce the clinical complications.

HOW TO CITE THIS ARTICLE

Tarannum, Ravichandra KS, Muppa R, et al. Molar Incisor Hypomineralization Prevalence in the Schoolchildren of Gannavaram Mandal, Krishna District, Andhra Pradesh, India: A Cross-sectional Study. Int J Clin Pediatr Dent 2021;14(6):737-740.

Is there an association between dental caries, fluorosis, and molar-incisor hypomineralization?

Objective:

This cross-sectional study aimed to determine the prevalence of dental caries, dental fluorosis, and molar-incisor hypomineralization, and their associations in a group of Brazilian schoolchildren.

Methodology:

Adolescents (n=411) were evaluated by two calibrated examiners for dental caries (DC), dental fluorosis (DF), and molar-incisor hypomineralization (MIH) using the CAST (Caries Assessment Spectrum and Treatment) instrument, Thylstrup and Fejerskov (TF) index, and MIH Severity Scoring System (MIH-SSS), respectively. Descriptive statistics, chi-square tests, and logistic regression were used for statistical analysis.

Results:

The sample comprised 42.75% boys and 57.25% girls. The prevalence of DC in permanent dentition was 94.75%, of which 29% were represented by dentin lesions. For DF, a prevalence of 40.75% was observed, with 69.32% mild, 12.88% moderate, and 17.79% severe. A positive association between the source of water and fluorosis was detected (p=0.01). The prevalence of MIH was 18%. Thirty adolescents (41.7%) presented with severe MIH. No association was found between DF or MIH and dentin DC or between MIH and DF at the individual level. However, a significant negative relationship was detected between DF and dentin carious lesions ( p <0.005) and DF and MIH ( p <0.00001) at the tooth level, whereas a positive association was observed between MIH and dentin carious lesions ( p <0.00001). A positive association was also observed between the severity of both conditions ( p <0.00001). Mild DF was the most prevalent problem observed. Cases of teeth with mild MIH were the most predominant in MIH-affected teeth.

Conclusions:

No association was observed among the dentin carious lesions, MIH, and DF at the participant level. However, a positive association between MIH and dentin carious lesions was found at the tooth level, whereas MIH, DF, and DF and dentin carious lesions showed a negative relationship.

Molar-incisor hypomineralization (MIH), dental fluorosis, and caries in rural areas with different fluoride levels in the drinking water

AIM

This study determined the prevalence of molar-incisor hypomineralization (MIH) and its association with dental fluorosis and caries in children living in rural areas in north-eastern Brazil who are exposed to residual fluoride (F) levels in the drinking water.

DESIGN

A census was carried out with 610 schoolchildren aged 6 to 12 years. The European Academy of Paediatric Dentistry criteria, Thysltrup and Fejerskov index, and World Health Organization index were used for diagnosis of MIH, dental fluorosis, and caries detection, respectively. The association between the outcome and exposure variables was determined by robust Poisson regression (P < .05).

RESULTS

Water F-levels varied from 0.06 to 1.98 ppm. MIH was not related to fluoride levels in the drinking water, but it showed an inverse and direct correlation with dental caries and fluorosis, respectively. Children with MIH had a higher DMFT, and severe MIH cases were most frequent in children with dental fluorosis.

CONCLUSION

Drinking water F-levels were not directly related to the occurrence of MIH in schoolchildren. The severity of MIH, however, was likely to be associated with dental fluorosis in areas with moderate to high fluoride levels in the drinking water.

Prevalence of Dental Caries in the Indian Population: A Systematic Review and Meta-analysis

Objectives:

To evaluate the pooled prevalence of dental caries among Indian population through systematic review and meta-analysis.

Materials and Methods:

A keyword search was conducted in PubMed, Science Direct, Google Scholar, Cochrane, and Scopus databases using relevant key words to extract the data pertaining to dental caries in Indian population. The search criteria included manuscripts published in English language from March 2009 to March 2019 and employed standard Boolean operators. The studies which met the inclusion criteria were independently reviewed by two researchers and their quality was assessed by the Newcastle–Ottawa Scale. The overall prevalence was deduced using the random effects model with prime focus given to the site of anatomical origin. R software version 3.5.2. was used for statistical analysis.

Results:

Post screening, out of the 253 articles identified, 70 met the inclusion criteria and were used to generate the meta-analysis. Among them, only few studies investigated the prevalence of root caries (n = 1). Overall prevalence of dental caries was 54.16% (CI: 0.4966–0.5866), whereas age-specific prevalence was 62% in patients above 18 years and 52% among 3–18 years of age (P < 0.0001). Maximum overall prevalence was noted in mixed dentition (58%). Region wise prevalence was more in western India (72%). Use of decayed, missed, and filled teeth as diagnostic criteria for early childhood caries was only 29%.

Conclusions:

Besides an overall prevalence of 54.16%, there exists a remarkable variation in dental caries prevalence rates as per age, diagnostic criteria, dentition, and geographical region. Furthermore, research should be focused on the prevalence of anatomical site specific caries as well.

Molar incisor hypomineralization: A review and prevalence in Japan

Molar incisor hypomineralization (MIH) is defined as hypomineralization of systemic origin of one to four first permanent molars, and incisors are also frequently affected. This disorder is a serious concern in pediatric dentistry. Teeth affected by MIH have many dental problems, such as hypersensitivity, poor aesthetics, and rapid progression of dental caries. The prevalence of MIH ranges from 2.8% to 21% among studies with more than 1000 subjects in different countries and age groups. The etiology of MIH is unclear, but genetic and environmental factors have been proposed. This review describes the prevalence, etiology, and clinical management of MIH. A detailed description of MIH prevalence in Japan is also provided.

Molar incisor hypomineralization (MIH): prevalence and degree of severity in a Mexican pediatric population living in an endemic fluorosis area

OBJECTIVE

To estimate the prevalence and severity of molar incisor hypomineralization (MIH) in 8 years old children living in an endemic fluorosis area.

METHODS

MIH prevalence rate was determined from a study sample comprising 613 participants. They were recruited from 11 urban public schools with similar socio-economic status. Oral evaluations were performed and diagnosed MIH teeth were classified under Ghanim et al.'s criteria. Statistical descriptive and comparative analyzes were carried out.

RESULTS

First permanent molars were the tooth group most affected, followed by the upper central incisors, lower central incisors, lower lateral incisors, and upper lateral incisors. There was no significant statistical difference by gender and by maxillary/mandible arches (P = 0.82 and 0.26, respectively). The frequency of MIH was more in molars compared to incisors (P < 0.02).

CONCLUSIONS

The MIH prevalence in this study was 12.4 percent. According to the MIH severity, degree 2 was the most frequently detected (76.4 percent).

Prevalence of molar-incisor hypomineralization in Milwaukee, Wisconsin, USA: a pilot study

Purpose: This pilot study investigated the prevalence of Molar-Incisor Hypomineralization (MIH) in third-grade school children in Milwaukee Wisconsin, USA. Methods: A convenience sample of third-grade school children in the Milwaukee Public School System (MPS) participated in the study. Calibrated examiners trained on the European Academy of Paediatric Dentistry (EAPD) MIH recommendations examined the children between December 1, 2014 and June 30, 2015. Children were examined at their schools using a flashlight and mirror after receiving consent from parents/caregivers and assent from each child. Findings were recorded onto a standardized form by one of five trained examiners. Summary statistics were calculated, and bivariate analysis were done to identify factors associated with MIH. Results: A total of 375 children (average age =8.66 years, range 7-12) were examined, 60% females and 41% Hispanics. Overall, 36 (9.6%) of the children demonstrated findings consistent with the diagnosis of MIH. Among the teeth with MIH defects, severe defects were higher in lower molars. There were no statistically significant differences between those with and without MIH by sex, race/ethnicity, and socioeconomic status in this study. Conclusion: The study revealed that 9.6% of the children examined were affected by MIH. Future studies should focus on statewide and/or nationwide surveys in the United States to ascertain the extent and severity of the condition.

Molar Incisor Hypomineralization-An Emerging Burden: A Short Study on Prevalence and Clinical Characteristics in Central Delhi, India

Aim

To determine the prevalence of molar incisor hypomineralization (MIH) in 6–12 years old children of the Central Delhi area.

Materials and methods

This cross-sectional descriptive short study consisted of 1,026 children aged 6–12 years selected by a random sampling procedure. The parents were interviewed and relevant prenatal, perinatal, and postnatal history was recorded. The dental examination was carried out by well-trained pediatric dentists. Full mouth examination of teeth was conducted including the European Academy of Pediatric Dentistry (EAPD) 2003 criteria for the diagnosis of MIH. The results were documented and statistically analyzed using the Chi-square test.

Results

The prevalence of MIH was found to be 1.17%. There was statistically significant difference in prevalence related to gender (p < 0.05) with a higher number of males affected with MIH. A total of 77 teeth (44 molars and 32 incisors) were observed with MIH. The severity of MIH was more in molars (52.27%) when compared to incisors (24.24%). All the four first permanent molars were affected in 83.3% of children with MIH.

Conclusion

The prevalence of MIH in a small sample of 1,026 children aged 6–12 years in Central Delhi was 1.17%. A significant male predilection was reported. MIH is a developmental disturbance occurring during the maturation phase of enamel formation, which requires a multidisciplinary treatment approach. The high esthetic demand and the inability to deliver successful restorative care to the hypomineralized teeth can pose great difficulties. Hence, more studies related to prevalence, nature, and severity of MIH and awareness regarding the associated risk factors are required to reveal the hidden burden across the country and to further prevent the occurrence of MIH.

How to cite this article

Goswami M, Bhushan U, et al. Molar Incisor Hypomineralization—An Emerging Burden: A Short Study on Prevalence and Clinical Characteristics in Central Delhi, India. Int J Clin Pediatr Dent 2019;12(3):211–214.

Prevalence and etiology of molar-incisor hypomineralization (MIH) in the city of Istanbul

Background/purpose

Molar-Incisor-Hypomineralisation (MIH) is the term used to depict a condition in which one or more of the permanent molar teeth and usually no less than one incisor tooth is hypomineralised and the prevalence rates vary from 2.4 to 40.2%. The aim of this study was to assess the prevalence and the risk factors of MIH in children in Istanbul, Turkey.

Materials and methods

A total of 1511 (760 M, 751 F), 8- to 11-year-old children were examined who had their first permanent molar and incisors evaluated using the EAPD criteria for MIH. Hypomineralized molars and incisors were recorded based on developmental defects of enamel index. The potential aetiological factors were retrieved through personal interview and etiological questions were asked to the parents. Statistical analysis was performed with a chi-Square test.

Results

MIH was observed in 215 (14.2%; 102 male, 113 female) children. The sample (1511 children) comprised 71 (9.9%) 8 year-olds with MIH and 144 (18.2%) 11 year-olds with MIH. A significant difference was found between 8 (9.9%) and 11-year-old (18.2%) children with MIH (p ≤ 0.001). Complications during the mother's pregnancy, birth prematurity, average breast feeding period, diarrhea frequency, digestive system diseases, asthma, frequent high fever, ear infection, renal failure, rubeola, chickenpox and parotitis were found to be significantly associated with MIH (p < 0.001).

Conclusion

There are many events that can cause MIH which we cannot control or predict. Therefore, longitudinal studies with large sample size are needed so as to determine how various likely etiological factors described affect the etiological role.

Efficacy of Intraosseous Local Anesthesia for Restorative Procedures in Molar Incisor Hypomineralization-Affected Teeth in Children

Background

Treatment of teeth affected with molar incisor hypomineralization (MIH) in young patients is challenging due to chronic subclinical pulpal inflammation caused by porous enamel and exposed dentin. Hypersensitivity of the teeth and difficulty in achieving local anesthesia due to altered nerve potential affects the successful completion of the treatment.

Aim

The aim of the study was to compare the anesthetic efficacy of the intraosseous (IO) anesthetic technique with conventional local infiltration technique in anesthetizing first permanent molars (FPMs) affected by MIH for restorative procedures in children.

Materials and Methods

This randomized controlled clinical trial recruited 54 MIH-affected mandibular or maxillary FPMs requiring restorations or stainless steel crowns. The teeth were randomly allocated to two equal groups to receive either IO injection or buccal infiltration (control), both using 4% articaine. Onset, time required, and pain experienced for administration, need for repeat, efficacy of anesthetic technique, heart rate, and postoperative complications were recorded in both the groups. Collected data were subjected to statistical analysis.

Results

Onset was significantly faster and pain experienced during administration was significantly lower with IO technique. Need for repeat of anesthesia was significantly more with infiltration (44.4% vs. 7.4% in IO, P = 0.004). Local infiltration failed to produce profound anesthesia in 74.1% MIH-affected teeth. IO anesthesia profoundly anesthetized 88.9% MIH-affected teeth. Anesthetic efficacy was significantly better with IO anesthesia (P < 0.001). Postoperative complications were significantly lower with IO anesthesia (P = 0.003).

Conclusion

IO local anesthesia was found to be an effective and safe technique to achieve profound anesthesia in MIH-affected teeth in children in comparison to local infiltration.